A different slant on the AA/CRNA issue..

[Gasworks]

---

Members don't see this ad.

DO YOUR OWN $%&$$%@! CASES. Why is there a constant push to find non-physicians to squat in a room while you play bejeweled all day in the lounge? Is there truly so much volume in your practice that you can't find qualified MD's to fill the group? Are you a greedy piggy and enjoy billing for work that is done by a subordinate?

I hired a new landscaper this summer. The guy came to my house with a shirt and a tie. He gave me a professional and detailed assessment of my needs and came up with 3 month plan to rehabilitate my lawn and change my shrubbery to accent the stone work I had done last year. He had a diploma, was a member of some state society and had an entire folder of references. That meeting was in march and I have NEVER seen him since. He just sends a crew of day laborers to mow my lawn and guess what I cut a side deal with his guys to come back next year at HALF the price.

I had to search high and low to find the all MD group I am currently with. I left a job which had crna's in a 1:1 ratio for at least half the locations we covered. How shameless is it to sign a chart and wander off to the lounge when you have JUST 1 ROOM TO COVER???? (Note: this was part of a university group so nobody cared about finances)

Now people want to go out and send their anesthesia techs to some technical school for a fancy AA degree and leave an even less qualified person in the room to kill the patient.

End of rant.

DO YOUR OWN F$&%@ING CASES.

 

[jwk]

DO YOUR OWN $%&$$%@! CASES. Why is there a constant push to find non-physicians to squat in a room while you play bejeweled all day in the lounge? Is there truly so much volume in your practice that you can't find qualified MD's to fill the group? Are you a greedy piggy and enjoy billing for work that is done by a subordinate?

I hired a new landscaper this summer. The guy came to my house with a shirt and a tie. He gave me a professional and detailed assessment of my needs and came up with 3 month plan to rehabilitate my lawn and change my shrubbery to accent the stone work I had done last year. He had a diploma, was a member of some state society and had an entire folder of references. That meeting was in march and I have NEVER seen him since. He just sends a crew of day laborers to mow my lawn and guess what I cut a side deal with his guys to come back next year at HALF the price.

I had to search high and low to find the all MD group I am currently with. I left a job which had crna's in a 1:1 ratio for at least half the locations we covered. How shameless is it to sign a chart and wander off to the lounge when you have JUST 1 ROOM TO COVER???? (Note: this was part of a university group so nobody cared about finances)

Now people want to go out and send their anesthesia techs to some technical school for a fancy AA degree and leave an even less qualified person in the room to kill the patient.

End of rant.

DO YOUR OWN F$&%@ING CASES.

Congratulations - do your own cases if that's what you want to do. There are in fact still all-MD groups out there, so if that's your preference, by all means do it.

But learn some facts while you're at it. There aren't enough anesthesiologists to go around to have every anesthetic in the US administred by an anesthesiologist. Period. There just aren't. You know it - this is your quote from another thread >>>>> No matter how much or how little effort goes into the political fight the fact remains that bringing just 1000 new anesthesiologists into the pool each year will never meet that demand for anesthesia services

"Even less qualified" than whom? I'm not sure what your problem is with AA's, but its not technical school. It's a master's program (started while CRNA's were still getting certificates) tied in with a university medical school. Some of the bigger names in anesthesiology in the last 40 years have been very involved with AA education and supporting the AA concept. If you have a problem with mid-level providers in general, I can understand that. Just don't single out AA's when you obviously have NO clue what you're talking about.

 

[maceo]

Congratulations - do your own cases if that's what you want to do. There are in fact still all-MD groups out there, so if that's your preference, by all means do it.

But learn some facts while you're at it. There aren't enough anesthesiologists to go around to have every anesthetic in the US administred by an anesthesiologist. Period. There just aren't. You know it - this is your quote from another thread >>>>> No matter how much or how little effort goes into the political fight the fact remains that bringing just 1000 new anesthesiologists into the pool each year will never meet that demand for anesthesia services

"Even less qualified" than whom? I'm not sure what your problem is with AA's, but its not technical school. It's a master's program (started while CRNA's were still getting certificates) tied in with a university medical school. Some of the bigger names in anesthesiology in the last 40 years have been very involved with AA education and supporting the AA concept. If you have a problem with mid-level providers in general, I can understand that. Just don't single out AA's when you obviously have NO clue what you're talking about.

I thought it was usually 1:3 or 1:4. It is very very difficult managing 3 -4 rooms. Its hard. i would hardly call it sitting in the lounge. I do all of my own cases now, I dont know how much longer it is going to last. Nobody can force me to supervise. I do go on locums assignments on my 8 plus weeks off and i supervise. Its hard as hell.

 

[B-Bone]

I second the fact that there aren't enough MDs to sit all the anesthetics in the country. Maybe people in other parts of the country don't know this, but there are large pockets of the country with no MD-only practices. I live in a decent sized city in the Midwest and there are no MD-only practices in the city or the suburbs, or anywhere around here. It's all ACT. If you want to practice anesthesia in this state, you're going to be supervising. My group supervises 90% of the time, and sits our own cases 10% of the time. We're generally 3:1 supervision except in cardiac where our surgeons demand our presence pretty much throughout the case, when we're 1:1 or 2:1. Our hospitals have separate contracts with us and the CRNA's and we all work together to take care of patients and make money. Our CRNA's aren't allowed to do any regional, spinals, lines (even art lines), induce anesthesia, etc. They know the deal. Not all CRNAs are radical crazies trying to take our jobs. The ones I work with know they need us, and like having backup all the time. They approached our group when the local SRNA training program talked about transitioning to a doctoral program and asked whether we'd be comfortable letting these students rotate at our hospitals. We told them no, and they dropped it.

Bottom line is, when I'm supervising, I make the anesthesia plan. I induce, wake up, do the lines, do the blocks, take the difficult airways, preop/postop the patients, do procedures in the ICU (all for 3-4 rooms worth of patients). I do not empty the urine bottle. If anybody thinks that makes me a lazy money-grubbing bastard with no clinical skills, so be it. I sleep well at night knowing my patients are well taken care of and I love my job.

 

[Coastie]

I second the fact that there aren't enough MDs to sit all the anesthetics in the country. Maybe people in other parts of the country don't know this, but there are large pockets of the country with no MD-only practices. I live in a decent sized city in the Midwest and there are no MD-only practices in the city or the suburbs, or anywhere around here. It's all ACT. If you want to practice anesthesia in this state, you're going to be supervising. My group supervises 90% of the time, and sits our own cases 10% of the time. We're generally 3:1 supervision except in cardiac where our surgeons demand our presence pretty much throughout the case, when we're 1:1 or 2:1. Our hospitals have separate contracts with us and the CRNA's and we all work together to take care of patients and make money. Our CRNA's aren't allowed to do any regional, spinals, lines (even art lines), induce anesthesia, etc. They know the deal. Not all CRNAs are radical crazies trying to take our jobs. The ones I work with know they need us, and like having backup all the time. They approached our group when the local SRNA training program talked about transitioning to a doctoral program and asked whether we'd be comfortable letting these students rotate at our hospitals. We told them no, and they dropped it.

Bottom line is, when I'm supervising, I make the anesthesia plan. I induce, wake up, do the lines, do the blocks, take the difficult airways, preop/postop the patients, do procedures in the ICU (all for 3-4 rooms worth of patients). I do not empty the urine bottle. If anybody thinks that makes me a lazy money-grubbing bastard with no clinical skills, so be it. I sleep well at night knowing my patients are well taken care of and I love my job.

👍

 

[leaverus]

I second the fact that there aren't enough MDs to sit all the anesthetics in the country. Maybe people in other parts of the country don't know this, but there are large pockets of the country with no MD-only practices. I live in a decent sized city in the Midwest and there are no MD-only practices in the city or the suburbs, or anywhere around here. It's all ACT. If you want to practice anesthesia in this state, you're going to be supervising. My group supervises 90% of the time, and sits our own cases 10% of the time. We're generally 3:1 supervision except in cardiac where our surgeons demand our presence pretty much throughout the case, when we're 1:1 or 2:1. Our hospitals have separate contracts with us and the CRNA's and we all work together to take care of patients and make money. Our CRNA's aren't allowed to do any regional, spinals, lines (even art lines), induce anesthesia, etc. They know the deal. Not all CRNAs are radical crazies trying to take our jobs. The ones I work with know they need us, and like having backup all the time. They approached our group when the local SRNA training program talked about transitioning to a doctoral program and asked whether we'd be comfortable letting these students rotate at our hospitals. We told them no, and they dropped it.

Bottom line is, when I'm supervising, I make the anesthesia plan. I induce, wake up, do the lines, do the blocks, take the difficult airways, preop/postop the patients, do procedures in the ICU (all for 3-4 rooms worth of patients). I do not empty the urine bottle. If anybody thinks that makes me a lazy money-grubbing bastard with no clinical skills, so be it. I sleep well at night knowing my patients are well taken care of and I love my job.

Gawd, i WISH our practice were like this. Our CRNAs are pretty much independent. They do the whole case on their own from start to finish and their own lines and blocks. We neither supervise nor direct, but at the end of the day i'm taking the liability by co-signing the charts of patients i've never laid eyes on. I'm in a decent sized city in the Midwest as well.

 

[Coastie]

Gawd, i WISH our practice were like this. Our CRNAs are pretty much independent. They do the whole case on their own from start to finish and their own lines and blocks. We neither supervise nor direct, but at the end of the day i'm taking the liability by co-signing the charts of patients i've never laid eyes on. I'm in a decent sized city in the Midwest as well.

uh...then what do you do all day..and why would you "work" at a place where you don't do anything related to the anesthetic except sign a chart?

 

[leaverus]

uh...then what do you do all day..and why would you "work" at a place where you don't do anything related to the anesthetic except sign a chart?

Sorry, forgot to mention that we (docs) are concurrently doing cases. I work there because the pros outweigh this big con; the surgeons and nursing staff are all great to work with and the hospital is conveniently located for me. And before you state the obvious, as i'm not a partner, i have no say in this "model" and there are no MD-only groups in this entire state.

 

[periopdoc]

DO YOUR OWN $%&$$%@! CASES.

...guess what I cut a side deal with his guys to come back next year at HALF the price.

Sure, bury our heads in the sand and refuse to work with CRNA's and AA's. Guess where that will get us? CRNA's will get independent practice rights cause there are no MD's to work with them in ACT's and there aren't enough anesthesiologists to perform all the anesthetics solo. Then guess who will be cutting a deal with with YOUR employers for half price while you are sitting in the OR with your fancy degrees, folder of references, etc?

I am lucky enough to be in an all MD practice for now, but I am not naive enough to bank on the indissolubility of this arrangement. It is very likely that 20 years hence, the vast majority of intraoperative care will be provided by midlevels with MD supervision, much like ICU care is now provided by RN's. I believe that we still have a brief window of opportunity to effect which mid-levels will be providing the care and what their level of supervision will be.

OOORR we can continue to bury our collective heads in the sand and let the Shalala's of the world define what anesthesia, and indeed all of medicine, will look like in America's future.


- pod